Monkeypox response relies on trade-offs without federal aid

Cases have depleted resources at sexual health clinics

A physician assistant talks with a man after he received the monkeypox vaccine at Families Together of Orange County in Tustin, Calif., in August. The Jynneos vaccine consists of two doses administered 28 days apart.  (Getty Images)
A physician assistant talks with a man after he received the monkeypox vaccine at Families Together of Orange County in Tustin, Calif., in August. The Jynneos vaccine consists of two doses administered 28 days apart. (Getty Images)
Posted September 28, 2022 at 5:11pm

The lack of spending for monkeypox in the temporary government spending bill moving through Congress means that states will have to take a patchwork approach to paying for the ongoing public health crisis in the short term, the Biden administration said Wednesday.

While the White House had asked for $4.5 billion to combat monkeypox as part of the continuing resolution, Republicans opposed new public health spending. Democrats ultimately opted to drop the monkeypox money in the hopes of easily passing a "clean" funding bill.

The White House now hopes to secure funding for monkeypox treatment and prevention in an expected omnibus bill, which Congress must pass by Dec. 16, barring additional stopgap extensions of current federal funding levels.

But until then, states and monkeypox clinics must rely on temporary funding streams freed up by new White House National Monkeypox Coordinator Bob Fenton and Deputy Coordinator Demetre Daskalakis when they stepped into their posts.

The Health Resources and Services Administration's HIV/AIDS bureau signaled in August that Ryan White program resources for people with HIV could be used for monkeypox testing and vaccinations, and the Centers for Disease Control and Prevention has freed up resources meant for HIV to be used for monkeypox, Daskalakis told reporters Wednesday.

"We're really looking to have people braid these resources together," said CDC Director Rochelle Walensky. "It may be that you can't come up with all the resources you need from a single place."

She said she recognized that the patchwork approach can be "logistically and administratively cumbersome."

While the approach provides a bridge, advocates and those working in the field say they worry about the future of funding.

"That is only temporary. We still have a need for these additional resources," said David Harvey, executive director of the National Coalition of STD Directors.

The coalition plans to lobby Congress to include funding for sexually transmitted infection clinics in the year-end omnibus bill. Harvey also said that the coalition is preparing to send the White House a proposal to end STIs in the United States with a program that looks similar to the Trump administration's initiative to end HIV.

Nationally, monkeypox reported daily cases are declining weekly, Walensky said Wednesday, but the influx of cases has left many sexual health clinics with depleted resources.

New data shows the vaccine is working. Those who were recommended for monkeypox vaccination and did not receive it are 14 times more likely to be infected with the virus than those who received a single dose of the Jynneos monkeypox vaccine. But peak virus protection occurs two weeks after the second shot, so the CDC still highly recommends people continue with the full vaccination regimen.

Kaiyti Duffy, chief medical officer at the Los Angeles LGBT Center, said that during the COVID-19 vaccination effort, many community clinics that distributed vaccines were reimbursed for their time and efforts because distributing vaccines is outside their usual scope of care.

To date, her clinic has not received any reimbursement for monkeypox vaccinations.

"It is overwhelming for a community clinic to take on an outbreak of this size without the support that we need from the state and from the federal level. Just in the same way as we responded to COVID, we have to do this here and now. Otherwise, it's institutional homophobia," Duffy said.